<strong>Scientific</strong> <strong>Session</strong> 14—Neuroradiology: Head and NeckWednesdayConclusion: ACE-I-induced small bowel angioedema should be stronglyconsidered as the diagnosis when patients on ACE-I therapy presentwith abdominal complaints and the following combination of findings onCT: ascites, small bowel thickening, dilatation without obstruction, andstraightening, with preserved intestinal transit.115. Etiology of Small Bowel Thickening on CT and Small Bowel SeriesFinkelstone, L. 1 ; Wolf, E. 2 ; Stein, M. 2 * 1. Albert Einstein College ofMedicine, Bronx, NY; 2. Montefiore Medical Center, New Rochelle, NYAddress correspondence to M. Stein (steine01@gmail.com)Objective: Small bowel thickening on CT is a nonspecific finding withmany potential causes. Our objective was to obtain the final diagnosis incases of small bowel thickening visualized on CT and small bowel series(SBS) to determine the frequencies of underlying causes.Materials and Methods: Retrospective chart review was performed of patientswho had abdominal CT, SBS, or both demonstrating small bowelthickening from January through December 2008. Our electronic patient filechart was used to analyze admitting diagnosis, discharge diagnosis, physicians’notes, laboratory values, colonoscopy and endoscopy reports, andother pathology results to identify the final diagnosis in these cases. The finaldiagnosis was sorted into ten different diagnostic categories, including infectious,reactive inflammatory, primary inflammatory, small bowel obstruction,iatrogenic, neoplastic, ascites, ischemic, miscellaneous, and unknown.Results: Four hundred forty-six patients had small bowel wall thickeningidentified on CT during this time period. Causes included: infection,113/446 (25.3%); reactive inflammatory, 69/446 (15.5%); primary inflammatory,62/446 (13.9%); small bowel obstruction, 38/446 (8.5%);iatrogenic, 33/446 (7.4%); neoplastic, 32/446 (7.2%); ascites, 30/446(6.7%); unknown, 28/446 (6.3%); ischemic, 24/446 (5.4%); and miscellaneous,17/446 (3.8%). During this same time period, 28 patients hadsmall bowel thickening on SBS. Diagnoses included primary inflammatory(16/28, 57.1%), unknown (7/28, 25.0%), neoplastic (2/28, 7.1%),reactive inflammatory (1/28, 3.6%), infectious (1/28, 3.6%), and smallbowel obstruction (1/28, 3.6%).Conclusion: Small bowel thickening on CT is most often of infectiousor inflammatory origin and this data can be used to formulate a morespecific differential diagnosis. It is difficult to draw conclusions from theSBS group due to the small number of patients.<strong>Scientific</strong> <strong>Session</strong> 14 —Neuroradiology: Head and NeckWednesday, May 4, 2011Abstracts 116-123116. Subclavian Steal Phenomenon on MRI: How Can We Steal theDiagnosis Without Contrast-Enhanced MR Angiography?Pearce, J.*; Abdel Aal, A.; Kim, Y.; Osman, S. University of Alabama-Birmingham, Birmingham, ALAddress correspondence to J. Pearce (jpearce@uabmc.edu)Objective: The purpose of our study is to outline a new method for diagnosisof subclavian steal using 3D time-of-flight (TOF) MR angiography (MRA)of the circle of Willis and 2D TOF MRA of the neck. This method will behelpful in patients with impaired renal functions in which contrast-enhancedMRA is not feasible due to the risk of nephrogenic systemic fibrosis.Materials and Methods: We retrospectively studied 11 patients at our institutionwho were diagnosed with subclavian steal by carotid ultrasound.We correlated the carotid ultrasound findings with those of 3D TOF MRAof the circle of Willis, 2D TOF MRA of neck, and contrast-enhancedMRA of the neck. We also correlated the carotid ultrasound and MRAresults with those of catheter angiography when available.Results: All our patients had subclavian steal (type IV waveform or completereversal of flow) by carotid ultrasound. Ten of our patients (91%)showed no signal intensity on 2D TOF MRA of the neck. Absence offlow in the vertebral arteries (VAs) on 2D TOF MRA of the neck denoteseither occlusion or reversal of flow. However, all our patients (100%)showed signal intensity on 3D TOF of the circle of Willis, denoting patency,and suggesting that lack of signal intensity on 2D TOF MRA ofthe neck was due to reversal of flow and not occlusion. Furthermore, fiveof our patients had 2D TOF MRA of the neck that extended cephalad tothe level of the VA confluence, showed signal intensity only in the mostcephalad segment of the VA.Conclusion: TOF MRA is flow-dependent luminal imaging. The most cephaladsegment of a patent VA (fourth segment) is visualized on 3D TOF MRAof the circle of Willis even if the flow is reversed as in subclavian steal, as aresult of the location of the saturation band above the 3D volume. Therefore,the use of 3D TOF MRA of the circle of Willis together with 2D TOF MRAof cervical arteries can suggest the diagnosis of subclavian steal without theneed for contrast-enhanced MRA of neck. Furthermore, 2D TOF MRA of theneck alone can suggest the diagnosis only if we add several cephalad slicesthat extend to the VA confluence. This is of utmost importance in patientswith impaired renal function in which contrast-enhanced MRA is not feasibledue to the risk of nephrogenic systemic fibrosis.117. Dynamic Contrast-Enhanced MRI of Medullary ThyroidCarcinoma at 3 TSammet, S.*; Liang, J.; Griffin, R.; Yang, X.; Shah, M.; Knopp, M. TheOhio State University, Columbus, OHAddress correspondence to S. Sammet (sammet.5@osu.edu)Objective: The purpose of this study was to investigate the changes in microcirculationof metastatic medullary thyroid carcinoma during a long-termantiangiogenic therapy with dynamic contrast-enhanced (DCE) MRI at 3 T.Materials and Methods: Eleven patients (mean age ± SD, 61 ± 15 years)with histologically confirmed metastatic medullary thyroid carcinomaswere enrolled in this phase II clinical trial of an RAF/VEGF-R kinase inhibitor.One baseline scan was performed prior to treatment and follow-upscans were scheduled every 8 weeks of therapy. DCE MRI using a gadoliniumchelate (Omniscan, GE Healthcare; 0.1 mmol/kg body weight) witha flow rate of 0.6 mL/s injected after the first five repetitions by a power injector(Spectris, MedRad) was performed on a 3-T MR scanner (Achieva,Philips) with a 3D spoiled fast field-echo sequence (TR/TE, 8/4; flip angle,20º; field of view, 250 mm; matrix, 256 × 256; inplane resolution, 0.98 ×0.98 mm 2 ; slice thickness, 5 mm; 20 contiguous slices; acquisition time,6.7 s; 70 time points) with a 2-channel surface coil.A44*Will present paper
Wednesday<strong>Scientific</strong> <strong>Session</strong> 14—Neuroradiology: Head and NeckResults: Characteristic contrast enhancement was observed in lesions, arteries,and benign nonvascular tissue. Twenty-five target lesions from 11patients were evaluated to monitor treatment. Follow-up scans revealedin nine of 11 patients significant decrease of K trans, k ep B, k epand k pe(p
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